MEDICARE: GRACE SANDERS LCSW, MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1750692729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE SANDERS LCSW, MSW

Provider Business Mailing Address
First Line	:	322 LAMAR AVE
Second Line	:	UNIT 303
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2436
Country	:	US
Telephone Number	:	980-288-4181
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 LAMAR AVE
Second Line	:	UNIT 303
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2436
Country	:	US
Telephone Number	:	980-288-4181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	10/10/2019

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